It is hypothesized that for elderly post-stroke patients improving upper extremity coordination, as well as strengthening its muscles may be accomplished simultaneously with cognitive training, and done in an entertaining way. This objective implements "a healthy mind in a healthy body" single-point-of-care approach. The long-term objective of this project is to develop an improved combined therapy approach that is superior to the way physical therapy and cognitive training are done separately today on the same patient population. The purpose of this investigation is to develop and feasibility test the prototype BC 100 system integrated with custom game-like virtual reality simulations, gravity-gradated assistance/resistance and grasp exertion. This system should accommodate both high-functioning and low-functioning patients post-stroke, being superior to off-the-shelf gaming systems and safer than rehabilitation robots. SPECIFIC AIMS The first aim is to develop the BC 100 system for improving arm/shoulder motion, motor control, endurance, grasp strength, memory, anticipation and reaction time in elderly patients post-stroke (subacute or chronic). The second aim is to evaluate the functionality of the prototype for elderly adults more than 1 moth post-stroke by piloting a 4-week intensive and simultaneous physical therapy and cognitive training of the affected upper extremity. METHODS 1) Construct the BC 100 system by creating a low-friction, vision-tracked rehabilitation table that tilts automatically to allow assistance/resistance to either arm motion;2) develop virtual rehabilitation software for elderly patients post-stroke with games training simultaneously the physical and the cognitive aspects their disability, while they are confined to log-term care;3) Develop a secure web-accessible database for reporting and remote data analysis. Data from the BC 100 will be sampled transparently in real time during play and uploaded to Bright Cloud International bladed servers. 4) pilot study with 4 elderly subjects without disability to uncover technology problems;5) Feasibility clinical study with 6 elderly subjects with hemiplegia following stroke participating in a 4-week training program of their affected upper extremity and cognition on the BC 100 systems. Subjects will be evaluated for physical and cognitive function using standardized tests at the start and end of training. Computerized non-standardized measures (arm reach, arm velocity, game scores, etc) will be compared to determine if there is a correlation with the standardized tests. NIH RELEVANCE This project will develop a new device and therapeutic method for training upper extremity and cognition in an integrated way providing a single-point-of-care solution. The same approach can be extended to other patient populations, and age groups. PUBLIC HEALTH RELEVANCE: A product that simultaneously augments the physical strength, cognition and well being of elderly patients confined to long-term care improves their quality of life/participation, and reduces health care costs by allowing them to work on rehabilitation games in their free time without the intervention of a therapist. By integrating rehabilitation for shoulder/arm/grasp control and strength with cognitive (memory, reasoning) training the product improves access to health care by facilitating a single-point team-care therapy. The ability of the product to also be used in the future in acute rehabilitation further reduces health care costs by accelerating return to productive life.